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"Ick" factor notwithstanding - faecal transplantation finding favour with physicians

posted 18 Oct 2012, 10:47 by Mpelembe   [ updated 18 Oct 2012, 10:48 ]

The idea of injecting the faeces of a healthy person into the gut of someone who's sick may be distasteful - even disgusting - to some, but increasingly, doctors are using faecaltransplantation to treat digestive tract infections. The results of a study into the unconventional treatment are to be presented to the Infectious Diseases Society of America meeting in San Diego on Friday (October 19) but one doctor in Sydney says he can already attest to its effectiveness.

SYDNEY, NSW, AUSTRALIA  (REUTERS) -  Colonoscopy is a common cancer prevention procedure carried out in clinics and hospitals all over the world. But today, the colonoscope is increasingly being used for a much less conventional treatment - faecal microbiota transplantation (FMT) where faeces, blended with saline, is transferred from a healthy person into a sick person.

For patients suffering debilitating infections caused by a bacterium called clostridium difficile, which leads to inflammation of the colon and even death, the Centre for Digestive Diseases (CDD) in Sydney reports a 90 percent cure rate using FMT, compared to no more than 20 percent using traditional antibiotics.

The often severe problems caused by clostridium difficile usually occur after antibiotic use during other medical treatments. While generally effective in fighting infection, antibiotics can also destroy the gut's naturally occuring flora - or "good" bacteria" - allowing C. difficile to overwhelm the colon. The overpopulation of C. difficile is harmful because the bacteria release toxins that can cause bloating, diarrhea and severe pain. In some cases it can lead to life-threatening diseases like toxic megacolon.

Clinical gastroenterologist, Professor Thomas Borody says faecal transplantationutilizes the body's natural chemistry.

"The fascinating thing is that the incoming healthy flora from somebody else, which is intact because it hasn't been damaged by antibiotics, has the capacity to manufacture antibiotics to kill the infection which we cannot kill with antibiotics ourselves," he said.

The procedure is straightforward. A colonoscope is inserted into the patient's bowel, at the top of the large intestine. A syringe containing the faeces/saline solution is then attached, and the mixture infused through the colonoscope. The camera inside the patient shows the transplanted liquid pouring into the intestine, while Professor Borody guides the colonoscope to ensure the liquid is spread throughout the colon. In a matter of minutes, the patient's bowel is full of the transplanted faecal slurry.

"Some people have what we call the 'ooh' factor, like that's, you know, gross type of thing, but once they get explained about the whole medical side of it, they seem to be okay with it," said nurse Danielle Grippi who works with Professor Borody.

Every working day a package containg human faeces arrives at the CDD. The stool sample will be used for the next FMT procedure.

The donated stool, containing healthy bacteria, is blended with the saline solution to make the mixture thin enough to flow through a tube. It is then filtered and transferred to large syringes ready for infusion into the patient.

Professor Borody says one of the most challenging aspects of the treatment is making patients comfortable with the idea of faecal transplantation.

"And the interesting thing from more than 550 odd publications on the use of FMT, there has not been one transmitted infection. Although you would think, that because our mind is so set that poo is dirty, you would think there would be some infections, and yeah, potentially there are. But I think we get more infections from restaurants than we do from FMT," said Borody.

After the intial procedure, patients undergo subsequent infusions performed with a simpler enema to help the good flora take over the gut. But soon, Borody says, he hopes the procedure can be replaced by a simpler method.

"In the future that product will be freeze dried and we expect to have a powder that can be put into a capsule, enteric coated, which means it can open up way down the small bowel, and already it has been tested in one patient so ultimately it will all be in a capsule form," said Professor Borody.

It may be some years before such a capsule is available on the market, although according to Borody, FMT will remain popular in its current form, simply because it works.